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Testimony on Social Security Disability Programs’ Challenges and Opportunities

TESTIMONY OF THE NATIONAL ASSOCIATION OF DISABILITY EXAMINERS

TO THE COMMITTEE ON WAYS AND MEANS SUBCOMMITTEE ON SOCIAL SECURITY

HEARING ON SOCIAL SECURITY DISABILITY PROGRAMS’ CHALLENGES AND OPPORTUNITIES

By Sue Heflin, President June 28, 2001

Chairman Shaw, Mr. Matsui, and members of the Subcommittee, on behalf of the National Association of Disability Examiners (NADE), thank you for this opportunity to share our views on the challenges and opportunities facing the Social Security disability programs today.

NADE is a professional organization whose mission is to advance the art and science of disability evaluation. Our membership includes Social Security Headquarters staff and Field Office personnel, attorneys, claimant advocates and physicians. However, the majority of our members are employed in the state Disability Determination Service (DDS) offices and are directly involved in processing claims for Social Security and Supplemental Security Income (SSI) disability benefits. It is the diversity of our membership, combined with our “hands on” experience, which we believe provides us with a unique understanding of the challenges and opportunities facing the Social Security and SSI disability programs today. Our members face these challenges on a daily basis.

We agree with the assessment of the Social Security Advisory Board in their February 2001 report that, “In recent decades, disability policy has come to resemble a mosaic, pieced together in response to court decisions and other external pressures, rather than the result of a well-thought out concept of how the programs should be operating…Policy and administrative capacity are dramatically out of alignment in the sense that new and binding rules of adjudication frequently cannot be implemented in a reasonable manner, particularly in view of the resources that are currently available.” This fragmented policy and lack of appropriate and adequate resources have seriously undermined the Social Security Administration’s ability to maintain fairness and consistency in the Social Security and SSI disability programs today.

We believe that the focus of this hearing is extremely important. The Social Security Administration spends two-thirds of its administrative budget, nearly $5 billion, on the disability program. Such a large expenditure justifies extensive oversight by this subcommittee to ensure that these funds are spent in a manner that delivers the best possible service for the taxpayer and the disabled.

While SSA’s administration of the retirement programs generally receives high grades in terms of public confidence and support, the public has significantly less confidence in the disability programs. In part this is due to the inconsistency in decisional outcomes between the states and regions. A larger factor, however, is the difference between DDS decisions and those made at the hearing level. There is a widespread public belief that “everyone” has his or her claim denied by the DDSs and must request a hearing before an Administrative Law Judge in order to receive benefits. In fact, this is not true. Eighty percent of the disability claims that are allowed, are allowed by the DDSs. However, the public’s perception of the disability program and the public’s confidence in the disability program is altered by the fact that there are widespread, unexplained differences in decisional outcomes between the different states and regions and between the different levels in the appeals process. These differences have undermined public confidence in SSA’s administration of the disability programs. The need to change this perception, and the reality that underlies it, must be viewed as one of SSA’s biggest challenges.

Disability decisions are not made in a nationally uniform and consistent manner. While to some extent this has always been true, it has become increasingly more pronounced in recent years. For several reasons, we are concerned that this trend will continue. New policies developed by SSA, both in response to, and independent of, court decisions and other litigation, have required that increasingly more weight be given to the subjective complaints of disability applicants. Similar impairments will affect different individuals in different ways. Assessing these subjective complaints necessarily has added to the growing belief that there is a general lack of consistency in what the public believes should be a uniform national program. Social Security lacks a clear and uniform quality review process that would provide consistent, meaningful feedback to all decision-makers. Quality assurance reviews and the “adjudicative climate” under which claims are reviewed, are inconsistent and reflective of –and convoluted by — politics and/ or litigation. Regulations are frequently promulgated and implemented before operating procedures, instructions and other tools have been developed. Decisions made by Administrative Law Judges are driven by court decisions while decisions made in the DDSs are controlled by program directives issued by SSA. SSA’s recent attempt to launch a new disability claims process, currently being prototyped in ten states, and the Agency’s efforts to direct DDSs to follow very specific regulations, collectively known as the Process Unification rulings, will increasingly require that DDS decisions be based on subjective complaints and treating source opinion, rather than the objective medical findings. We are pleased that the Administration recently decided to postpone national rollout of the Prototype initiative, pending additional review of its costs and benefits. However, while the national rollout has been delayed, those ten states that were involved in the prototype experiment continue to process claims in this manner while the rest of the country continues to adjudicate claims under the longstanding process. We are concerned that the public’s confidence in the disability program will be affected by the fact that nationally initial claims are being adjudicated under two distinctly different processes.

In order to increase the consistency and uniformity of disability decisions, the Social Security Administration must become truly “one SSA”. While NADE supports the current federal – state partnership structure, we believe that it must be strengthened to provide more effective oversight of the process. Individual state government “downsizing”, hiring freezes, and other aspects that are particular to the different states should not be allowed to interfere with the efficient operation of the DDS. In addition, SSA must continue with the development of a single presentation of policy that will be binding on all adjudicators. Ongoing communication between the Field Offices, the state DDSs and the ALJs must become a priority. Building trust between the various components in the disability program will be a major challenge for SSA but must also be viewed as a major opportunity. We applaud recent efforts by SSA and by the various components, to improve and maintain these lines of communication. We believe that these initial efforts, if continued, will provide a more consistent message to the public and to the individual applicant and should improve both the quality and the consistency of the decision.

In addition to ongoing communication and a single presentation of policy, NADE believes that ongoing, joint training for all decision-makers is essential if we are to provide fair, accurate and consistent decisions. This training must be clear and consistent and include interaction and discussion between the different components, including Field Office staff, DDS staff, and OHA staff. SSA’s use of technology based training, such as IVT, or Interactive Video Technology training, is a valuable training tool but it cannot replace the benefits derived from personal interaction and discussion. Technology based training, while certainly useful, must not be the sole mechanism for providing training.

Another major challenge for the disability program will be finding a suitable replacement for the Dictionary of Occupational Titles, or D.O.T. This publication, periodically compiled by the U.S. Department of Labor, has served as the guidebook for disability decisions made by the DDSs on claims that were decided on vocational issues. Unfortunately, the Labor Department has ceased compiling this information and SSA has not yet found a suitable replacement. Already, DDSs are beginning to struggle with decisions that are based on whether a claimant can return to past relevant work or to other work because the information at our disposal is outdated. Experiments with other tools, such as the O-net, have not proved beneficial thusfar. This problem will only get worse with the passage of time until and unless SSA is able to find a replacement for the information used daily by the DDSs in making their disability decisions.

SSA’s Quality Assurance process must be designed to provide nationally consistent feedback. The Agency recently received an extensive research report based on a study of its internal quality assurance process. This report, compiled by the Lewin Group, offered two general conclusions. The first was that, “Given the challenges faced by SSA, the design of the Prototype Process, and the current performance of the existing QA system, no amount of retooling, refocusing, redesign, tinkering, or the simple addition of resources to the existing QA processes will achieve SSA’s quality improvement goals.” The second general conclusion was, “The only way that SSA will achieve its quality objectives for the disability programs is to adopt a broad, modern view of quality management that includes efforts outside of OQA and the current quality assurance process.” NADE concurs with these conclusions. We are encouraged that SSA is now looking seriously at the quality assurance issue. We are concerned, however, that this initiative, like so many others that SSA is now considering, will be curtailed for lack of resources. This will be a mistake! Failure to devise an effective and meaningful quality assurance process would be to compromise the public’s confidence in the program. NADE has long supported the establishment of a Social Security Court. The development of– and decision on– an individual’s claim should not be dependent upon their residence or judicial jurisdiction. The ever-increasing complexity of disability claims, and the growth of medical technology, makes the need for a specialized court, with expertise in these matters, a necessity.

The state DDSs must have the necessary resources to hire and retain staff. This will be a major challenge for the disability program. The disability program has become increasingly complex. Because this is a medical – legal decision, disability examiners must necessarily have a thorough understanding of the medical, vocational and administrative/technical issues involved. It has been widely acknowledged that it takes at least two years for a disability examiner to become proficient in the performance of their job duties. Unfortunately, more than 50% of the disability examiners in the DDSs now have less than two years of experience. This will have a tremendous impact on the public’s confidence in the ability of SSA to render fair and timely decisions. The increasing turnover rate in the DDSs is due to the increasing complexity of the program and the failure of the DDSs to offer salaries commensurate with the job duties. The Social Security Advisory Board addressed this issue in its January, 2001 report and, while addresing the issue of salary levels in the DDSs, commented, “…the disability programs are national programs and SSA has an obligation to try to ensure equal treatment for all claimants wherever they reside.”

Another challenge that SSA will need to address is the growing issue of non-English speaking claimants. As our country’s diversity increases, so too will the need for the disability program to make the necessary accommodations for those claimants who do not communicate in English.

NADE does not support changing the definition of disability at this time. The current definition of disability provides a solid foundation for the disability program. While the ability of the remaining structure to support the program has been questioned, we do not believe that the foundation is weak. Having constructed a solid foundation, we believe that the best efforts of those charged with administering the program, and those charged with maintaining oversight of the program, should be directed at building stronger walls and other supports before constructing the roof. Unfortunately, we do not believe that this is the current practice.

We strongly support the goals and objectives of disability program reform as outlined by the Social Security Advisory Board in their February 2001 report:

· All who are truly disabled and cannot work should receive benefits · Those who can work but need assistance to do so should receive it · Vocational rehabilitation and employment services should be readily available and claimants and beneficiaries should be helped to take advantage of them · Claimants should be helped to understand the disability rules and the determination process · The disability system should ensure high quality decisions by well-qualified and trained adjudicators · The disability system should provide expeditious processing of claims. When cases are complex and require more time, claimants should be informed so that they will understand why there is delay

In addition to these goals, we believe that any action to reform the disability program should include the elimination of the five-month waiting period for Title II applicants. Currently, Title II disability beneficiaries must wait five full calendar months from the onset of their disability before they can begin receiving cash benefits. Title XVI (SSI) beneficiaries, on the other hand, can begin receiving benefits immediately. This fosters a perception that the Title II program is unfair to the disabled worker who has actually paid into the system. This is particularly evident in cases involving claimants with terminal illnesses when the claimants actually die during the waiting period and, therefore, do not collect any cash benefits. NADE has previously prepared a position paper on this issue and included a copy of this paper with prior testimony before this subcommittee. There is now proposed legislation before this subcommittee that would eliminate the five-month waiting period. This proposed legislation, H.R. 344, will also eliminate the 24-month waiting period for Medicare eligibility for the disabled. We commend the Congress for recently waiving this waiting period for disabled citizens with Amyotrophic Lateral Sclerosis, commonly known as Lou Gehrig’s disease. However, waiving this 24 month requirement for one group of disabled citizens, and not doing so for others, is discriminatory and may result in future litigation. We strongly believe in equal and fair treatment for all disabled citizens and strongly urge the Congress to give favorable consideration to H.R. 344.

We recognize the need to preserve the fiscal integrity of the Social Security disability fund and urge the Congress to consider revision of the medical improvement review standard. Under the current law, cessation of benefits can only occur if it can be shown that there has been medical improvement in a claimant’s impairment. While this concept may appear fair at face value, it ignores the fact that ever-increasing advances in medical technology make it possible for many disabled citizens to work. However, the lack of any incentive to pursue a return to work makes it unlikely that many disabled claimants will do so. While we do not support the cessation of benefits for those who are truly disabled and cannot return to work, we believe that the necessity of demonstrating medical improvement before cessation of benefits can occur is a deterrent to the Agency’s efforts to return disabled claimants to work. We also believe that the right of claimants to elect to continue benefit payments during the appeals process should be eliminated when the basis for the proposed cessation was the claimant’s failure to cooperate with the decision-maker. The fact that many claimants can continue to receive benefits during an appeals process that may take years because of their own failure to cooperate with the decision-makers is an affront to justice and an embarrassment to the disability program.

In conclusion, we would like to echo the opinion expressed by the Advisory Board, “…disability policy and administrative capacity urgently need to be brought into alignment.” This is critical in light of the likelihood of an increase in claims from the baby boom generation who are just now entering their most disability prone years. Disability workloads have grown in recent years and more growth is expected. However, the capacity of the DDSs and SSA to handle this growth in workloads has not. The Advisory Board’s report makes the emphatic point that, “Although there are many capable people working in the disability system, their efforts will be of little avail unless they have the tools they need to administer the program.” We strongly concur with this statement and ask that we be given the tools that we need to render fair and timely decisions so that the disabled citizens who come to us for assistance can be treated with respect and humanity.